Casts and Splints Hand Surgeon Hand Surgery Hand Therapy

Advice from a Certified Hand Therapist: What are my surgery precautions and why do I have to follow them?

You just completed your visit with your physician. He/she has likely given you a list of dos and don’ts after your injury or surgery. How important is it to follow these rules?  What could happen if these precautions are not followed?  What are the long-term effects of doing too much of a good thing or doing the wrong thing?

What happens if I remove my sling or brace before my doctor says it is OK?

Your doctor or therapist may provide you with a sling/cast/brace/orthotic and ask you to wear it “full time except for hygiene”.  Full time really does mean all of the time, including when you are up and about during the day and also for sleep.  The only time you can remove it is for a short period of time to bathe, keeping your arm still and securely by your side.  These instructions are important for a variety of reasons which include:

  • Not pulling on recently repaired structures by moving your arm too much
  • Allowing bones and/or soft tissue structures to heal in good alignment

What you might not know is that when the surgeon does a repair, it takes time for your body to heal by developing scar tissue on the inside as well as on your skin.  Scar tissue is not necessarily a bad thing because it is the glue that holds the damaged structures together.  If you are moving your arm too much or not wearing your supportive device as directed, you are not allowing your body to complete the cycles of healing. This can result in a failure of the repair.

Bones do not bleed like your skin, but after a fracture of the bone (broken bone) your body lays down a “scab” called a callus to heal the damaged bone.  Each week your body goes through a cycle to break down the initial callus and replace it with a stronger callus. This process can take as little as 4 weeks or as long as 12 or more weeks to fully heal after a fracture.  If you have been instructed to wear a sling/brace and you remove it prematurely, you can cause your bones to separate again which can lead to follow-up surgery and/or other complications like numbness, bone shortening, or long-term pain.

Why do I have to take care of my stitches?

The skin can be closed in one or multiple layers, depending on the part of the body that has been affected, using dissolvable or removable stitches.  These stitches are a direct line from the outside of your body  to the inside of your body, so keeping them clean is very important!  Soaking the hand in a bath or pool water can cause the stitches to break down prematurely, leading to bleeding and a much larger area for your body to heal and/or an infection.  Additionally, unless specifically instructed by your physician, avoid creams or ointments on your stitches.

Why did my doctor not include all of my joints in my brace or cast?

If you have an injury and you need a sling or brace that was mentioned before, pay close attention to the joints that are not included in your support.  Doctors and therapists only immobilize joints when absolutely necessary.  For example, if given a brace for your wrist, your fingers, elbow, and shoulder are perfectly free to move as normally as possible. Practice reaching at your shoulder, bending and straightening your elbow, turning your forearm over in a palm up and palm down position, and making a full fist with your fingers several times daily.  This will help to stop any stiffness in your non-involved joints which can cause pain and weakness.  It will also help you manage swelling by activating your lymphatic system with movement.

Following precautions is an extremely important part of the healing process. If you have questions, please reach out to your hand surgeon or hand therapist for help.  Each person heals differently and will need to be monitored closely to avoid any complications during their healing journey.  Adhering to precautions will help you get back to doing the activities you love as quickly as possible.

Gwen Morris, OTD, OTR/L, CHT, CLT is a Certified Hand Therapist and a member of the American Society of Hand Therapists.

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